Nutrition is the primary determinant of health and the backbone of
preventive medicine. Vegetarian nutrition represents the ideal in this respect.
Unfortunately, much of the information available to the public about nutrition
in general and vegetarian nutrition in particular is unreliable or inaccurate.
This page was developed to fill the need for evenhanded, scientifically correct
nutritional information from a legitimate physician authority in
nutrition.

Disclaimer: The material contained herein is intended to
provide general information about vegetarian nutrition as a public service and
should not be construed as personal medical advice. For medical advice on diet
or other matters, consult a competent physician.

There are many possibilities besides the obvious fruit and vegetable salads.
Soups of various kinds; spaghetti and other pasta dishes; vegetable stews;
casseroles; whole grains breads, rolls, bagels, and muffins; and a wide variety
of ethnic dishes are just some of the choices. There are soy, sesame, and other
vegetable-based burgers, and soy-based hot dogs as well. For convenience,
excellent frozen dinners are also available. When vegetarians gain familiarity
with foods that may be new to them, such as lacinato kale, tempeh, mustard
greens, or French lentils, they usually feel that their meals are more varied
than ever.

The taste of fat that most people are used to may be absent, but you will
soon learn to savor the subtleties of flavor of various vegetables, herbs, and
spices that will have you yearning for more. Your tastes will become more
sophisticated and you will enjoy the clean, fresh taste that food is supposed to
have.

Vegetarians live longer and become sick less often. Plant-based diets can
greatly reduce the incidence of heart disease, most of the major forms of
cancer, high blood pressure, obesity, adult-onset diabetes, kidney stones,
gallstones, and other chronic ailments.

Not really. To obtain the full spectrum of health-promoting phytochemicals
(plant nutrient-chemicals), you must consume the foods. Further, nutrients in
supplements do not always assume the same form as those in foods. Synthetic
beta-carotene supplements, for example, contain primarily one form of
beta-carotene, all-trans-beta-carotene. Foods also contain significant
amounts of the cis forms of beta-carotene, which may be stronger
antioxidants than the all-trans form.

Vitamin E provides another good example. Some studies show that vitamin E
from foods, as opposed to that from supplements, may help prevent certain
diseases. Why should this be? In nature, vitamin E assumes eight forms, four
tocopherols and four tocotrienols. Although alpha-tocopherol is the best known
of these forms, gamma-tocopherol predominates in the diet. This gamma-tocopherol
may be a better antioxidant than alpha-tocopherol with regard to certain
oxidants, and many tissues of the body seem to concentrate it. These findings
may explain why higher levels of gamma-tocopherol in the blood are associated
with a lower risk of heart disease. And the tocotrienol forms of vitamin E may
be even better antioxidants.

Unfortunately, vitamin E supplements, even those marketed as "mixed
tocopherols," generally consist primarily of alpha-tocopherol. Therefore,
supplements are not a good substitute for the full spectrum of dietary vitamin
E. The richest sources in the diet are soyfoods, whole grains (wheat germ),
pistachios, pecans, peanuts, walnuts, Brazil nuts, blackberries, and
blueberries.

On the contrary. Any poorly planned diet can be deficient, but, in general,
the risk of deficiency is lower with a vegetarian diet. True, vegetarians should
supplement with vitamin B-12. True, less iron and zinc is absorbed from the
average vegetarian diet as compared with the usual Western diet, although a well
balanced vegetarian diet should supply adequate amounts of both. And although it
is true that there is little vitamin D in unfortified vegetarian foods other
than mushrooms, vitamin D is really a hormone best obtained by exposure of the
skin to sunlight. On the other hand, vegetarian diets are much richer in
vitamins C and E, both important antioxidants. They are also much richer in
important minerals like magnesium and manganese, which are often lacking in
Western diets. Sufficient magnesium may help prevent a whole range of illnesses,
including osteoporosis, high blood pressure, adult-onset diabetes, kidney
stones, and heart disease. Vegetarian diets are much higher in fiber, which is
completely absent in animal products. Finally, vegetarian diets are much richer
in phytochemicals, plant nutrient-chemicals that may help prevent cancer, heart
disease, and many other problems. The deficiency in phytochemicals is probably
the biggest drawback of meat-based diets.

Deficiency of this vitamin results in cognitive (thinking, memory) and other
neurologic problems early on. Anemia often occurs later. Only 2.4 micrograms a
day of vitamin B-12 is necessary for adults with normal digestive systems
(slightly more for pregnant or lactating women). Modern hygienic methods of food
production eliminate soil-derived bacteria that produce vitamin B-12, so, aside
from animal products, fortified foods or supplements are the only reliable
sources. Foods that are sometimes fortified to provide the Recommended Dietary
Allowance include soy milk, cereals, and nutritional yeast. Otherwise, a
supplement of 1,000 micrograms weekly should be sufficient. Although eggs
contain some vitamin B-12, it may not be as well absorbed as that derived from
other animal products, so ovovegetarians should supplement somewhat as well.

Some people, especially the elderly (1 out of 8 persons over age 65), develop
vitamin B-12 deficiency because of gastrointestinal absorption problems, and
this occurs regardless of what they eat. For them, injections or high oral doses
under the supervision of a physician are necessary.

Vegetarian foods contain much iron although it is not as well absorbed as the
form of iron found in animal flesh. Too much iron may result in a pro-oxidant
effect, so a well-planned vegetarian diet may be the best way of obtaining
enough but not too much iron.

Tea inhibits iron absorption and should not be consumed with meals. Dairy
products contain almost no iron and may even inhibit iron absorption, so their
use should be minimized. Vitamin C greatly increases the absorption of iron from
plant foods, so vitamin C-rich foods consumed with meals can help. Many dark,
leafy green vegetables, potatoes, watermelon, and strawberries are examples of
foods that are good sources of both vitamin C and iron. Other good sources of
iron include lentils, garbanzo beans, almonds, sesame seeds, and blackstrap
molasses.

All other mammals obtain adequate calcium beyond the age of weaning without
drinking milk, so we should also be able to. Foods rich in well-absorbed calcium
include many dark, leafy green vegetables (kale, collards, bok choy, mustard
greens, broccoli), figs, almonds, tofu made with calcium sulfate, blackstrap
molasses and calcium-fortified orange juice. Loss of calcium in the urine can be
avoided by minimizing salt and sugar intake.

High protein intake, especially from animal flesh and eggs, also increases
calcium loss in the urine, although there is a compensatory increase in calcium
absorption from the digestive tract. The compensation may not be enough for
people with low calcium intake, however. In any event, high concentrations of
calcium in the urine probably increase the risk of kidney stones, which explains
why meat consumption is a major risk factor for this problem.

No. In children less than one year of age, cow's milk may cause intestinal
bleeding and promote anemia. It may also cause colic, even when consumed by a
mother who is nursing her infant. Cow's milk is very different from human milk,
being lower in iron, vitamin E, and essential fatty acids and too high in
sodium, potassium, and protein. The Committee on Nutrition of the American
Academy of Pediatrics has therefore recommended that cow's milk not be given to
infants under one year of age.

Does cow's milk suddenly become healthy, then, for children over age one? No.
Although controversial, milk consumption by children may increase the risk of
juvenile diabetes. In adults, it has been linked in some studies with lymphoma,
with prostate cancer, and with ovarian cancer. Also, the saturated fat in milk
can raise blood cholesterol levels. Children who do not drink milk, however,
should consume at least five servings of calcium-rich foods every day.

All whole foods, including grains, vegetables, and fruit, contain protein. If
you avoid "junk" foods and eat enough of a variety of whole foods to maintain
your weight, you should easily meet your protein requirement. The average
Western diet contains too much protein, which may increase the risk of kidney
stones and possibly other ailments.

Vegetarians do not need to "combine" any foods. "Complete protein" is a myth.
The protein in every whole vegetarian food contains all of the essential amino
acids, the building blocks of protein that must be supplied by the diet. True,
some vegetable proteins may have relatively more of some amino acids than of
others, but there's nothing that says we have to consume amino acids in the
exact proportion used by our bodies. In addition, if a person's diet is a little
low in certain amino acids, the body adapts and retains more of those amino
acids. If you ate enough of any one vegetable's protein to meet your daily
protein requirement, you would also be meeting your requirement for each of the
essential amino acids.

Refining of flour causes the loss of the majority of its nutrients. Most
people think mainly of fiber when they think of whole grain products. But most
of the mineral content, including magnesium, zinc, selenium, copper, and
manganese, is lost. Only iron is replaced. Some of the lost B vitamins are
replaced, but vitamin B-6 and pantothenic acid are not. Whole wheat flour is
rich in a wide spectrum of the natural forms of vitamin E, including the
tocotrienols with their special properties. Unfortunately, almost all of this
vitamin E is lost in the refining process as well. Important phytochemicals
(plant nutrient-chemicals) are also lost, including lutein and zeaxanthin, the
carotenoids that give whole wheat its golden color, and phenolic acids like
ferulic acid, which are antioxidants.

Although nutritional studies in the past often ignored the differences
between whole and refined grains, things are changing. A recent study from Italy
showed that people who infrequently consumed whole grains had five times the
risk of soft tissue sarcomas (cancer) as those people who consumed whole grains
frequently. Other studies have shown a lower risk of heart disease in women who
consume higher amounts of whole grains. The risk of adult-onset diabetes is also
reduced, despite the fact that products made with whole wheat flour raise the
blood sugar just as much as sugar does! Therefore, whether you're eating bread,
spaghetti, bagels, or rice, always choose whole grains.

Sugar, a natural constituent of fruits and vegetables, is present in every
diet. But excess sugar represents empty calories that fill you up, causing you
to avoid nutritious foods. It is also a cause of dental caries. Sugar causes the
loss in the urine of a number of important minerals, including calcium,
magnesium, zinc, and chromium, and these losses may increase the risk of certain
chronic diseases. Sugar may also increase the levels of the blood fats known as
triglycerides and lower the levels of HDL cholesterol (the "good" cholesterol)
in susceptible individuals.

Contrary to health food store mythology, refined sugar does not affect the
body any differently from unrefined sugar, and sugar does not have any immediate
ravishing effects on mind, body, or soul.

Preferred forms of sugar include blackstrap molasses, rich in both iron and
calcium, and fruit juice concentrates, which may retain a little of the fruit's
nutrients and phytochemicals.

There is abundant evidence that low-fat diets can lower the risk of heart
disease and cancer. They also make it easier to reduce the number of calories
consumed. The pronouncements of those favoring higher fat diets are usually
colored by personal dietary preferences. A low-fat diet may require some
adjustment to one's palate, but that change occurs readily over time.

I favor a diet with almost no added oils or fats, one deriving about 15% of
its calories from the fats naturally present in whole grains, vegetables, nuts,
and seeds. Whole wheat flour, for example, derives 5% of its calories from fat.
Ultra-low fat diets that derive less than 10% of calories from fat may show
impaired mineral absorption to some degree and will provide a lesser amount of
important fat-soluble nutrients and phytochemicals than diets that are somewhat
higher in fat.

One study showed that coronary atherosclerosis (hardening of the arteries)
could be reversed by a regimen that included a no added oil vegetarian diet,
exercise, and meditation (for stress reduction). Some would claim, though, that
a diet with added olive or canola oil can also produce a favorable cholesterol
profile in many people. However, cholesterol levels represent only one risk
factor for heart disease. The coagulability (tendency to form clots) of the
blood is felt to play a role in the atherosclerotic process as well, and dietary
factors are important here. It appears that consuming significant amounts of any
vegetable oil will increase the blood's coagulability. Furthermore, since
dietary fatty acids of all types appear along with cholesterol in
atherosclerotic plaques (areas of hardening of the arteries), oils may promote
coronary heart disease by other mechanisms as well.

The contention that oils may play a role in the development of heart disease
is supported by the results of the CLAS (Cholesterol Lowering Atherosclerosis
Study) study, which suggested that "protein and carbohydrate are preferred
substitutes for fat calories, rather than monounsaturated or polyunsaturated
oils."

The Mediterranean diet is a relatively healthy diet, but that does not mean
that it is the ideal dietary approach. True, olive oil contains flavonoids,
phytochemicals that my help prevent chronic diseases. But one can also obtain an
abundance of flavonoids with similar properties by consuming low fat fruits and
vegetables. Further, there is more to the Mediterranean diet than just olive
oil. It is a plant-based diet containing relatively modest amounts of animal
products. These dietary factors may be largely responsible for the beneficial
effects on health. Other factors, such as a low stress lifestyle, may also
contribute to the health of those in the Mediterranean region.

Since 20% of the cholesterol in the bloodstream derives from cholesterol in
food, high cholesterol foods should be avoided if one is serious about lowering
blood cholesterol levels. Although a few studies have not shown a
cholesterol-raising effect from the addition of eggs to the diet, these studies
generally involved people who were already consuming large amounts of
cholesterol. Adding cholesterol to such a diet often makes no difference.

However, eating cholesterol-rich foods like eggs appears to increase the risk
of heart disease independent of any cholesterol-elevating effect. The rise in
chylomicrons (fat-rich particles) in the blood after a cholesterol-rich meal may
directly promote hardening of the arteries. Further, egg consumption increases
the tendency of LDL-cholesterol (the bad form) to become oxidized, and this in
turn facilitates hardening of the arteries.

To ethical vegetarians, it's not healthy for the fish, most of which are
raised by aquaculture and live greatly restricted lives, much like warm-blooded
farm animals.

From the health standpoint, there is no good evidence that fish consumption
is of any benefit to people who are not at high risk for heart disease, and no
evidence at all that it would benefit low-risk people following healthful
vegetarian diets. The apparent short-term benefit to high-risk individuals may
be related to the ability of fish oils to reduce the risk of arrhythmias
(alterations in heart rhythm). By the way, magnesium, the best sources of which
include whole grains, green vegetables, legumes, nuts, and seeds, also has
antiarrhythmic properties.

Theoretically, fish oils have a number of other beneficial properties, such
as improving endothelial function (the ability of blood vessels to dilate when
necessary), lowering blood viscosity (thickness), and reducing inflammation. But
a healthful lifestyle incorporating a low-fat vegetarian diet provides similar
benefits.

On the negative side, fish oils promote the oxidation of LDL-cholesterol (the
"bad" cholesterol). This oxidation results in deposition of the cholesterol in
the walls of arteries (hardening of the arteries). Plant foods, on the other
hand, have the opposite effect. Another major negative is the contamination of
many fish by toxins and other pollutants. This includes farmed fish as well as
fish in the wild. Finally, as with all flesh foods, fish consumption increases
the risk of kidney stones.

We must keep two important points in mind when we evaluate studies looking at
the effects of fish consumption. First, we must consider that a beneficial
effect may be due to substituting fish for something more harmful, such as beef.
Second, we must take into account the observation that people with higher fish
intakes also tend to have higher intakes of fruits and vegetables. Therefore,
fish consumption may just be a marker for plant food consumption. In line with
these two precautions, one major European study found no association between
fish consumption and mortality from heart disease when flavonoids (a marker for
plant foods), saturated fats (a marker for animal products), and smoking were
controlled for.

Technically-minded people may want to read an important editorial by Dr.
Peter Markmann concerning the lack of benefit from fish consumption (American
Journal of Clinical Nutrition 2003;78:1-2).

The harnessing of fire as a tool by humans led to the cooking of food, which
stands in contradistinction to the eating habits of the rest of the animal
kingdom. Cooking destroys disease-producing organisms (usually a consequence of
animal agriculture), but are there any adverse effects on health? "Raw foods"
diets are trendy, but the arguments in favor of such diets by their advocates
are often unscientific. Nevertheless, a growing body of evidence indicates that
cooking foods more lightly or not at all may be beneficial to health.

First, cooking destroys nutrients, especially vitamin C and some of the
B-vitamins. Second, cooking can produce carcinogens (cancer-causing chemicals):
grilling of meat is a frequently cited example. Third, crushing (as with eating)
or cutting certain foods can activate beneficial enzymes (proteins that catalyze
chemical reactions) in uncooked but not in cooked foods. For example, activation
of the enzyme allinase in garlic converts alliin to allicin, a phytochemical
that may have anticarcinogenic (cancer preventive) properties. Similarly,
activation of the myrosinase enzyme in cruciferous vegetables causes the
formation of compounds that induce the production of the liver's phase 2 enzymes
that inhibit carcinogenesis and that may help prevent chronic diseases. Fourth,
cooking (especially at high temperatures and for long periods) causes the
formation of advanced glycoxidation end products (AGEs), which are felt to
promote aging and diabetic complications. Finally, uncooked foods are bulkier
than cooked foods and may, therefore, promote the intake of fewer calories per
day (see next question).

Although few of us are willing to give up cooked foods entirely, increasing
the percentage of food consumed in the raw state and cooking foods as lightly as
possible, e.g., avoiding toasting of bread and browning of other foods, would
seem prudent.

They are equally important, as shown by a growing body of evidence from
so-called dietary restriction or caloric restriction studies. In virtually every
animal, cutting calories to a level at least 30% below the amount consumed when
an unlimited food supply is provided causes a dramatic extension of life span
and a decrease in chronic, degenerative diseases. In humans as well as other
animals, dietary restriction appears to lower the risk of or even reverse
adult-onset diabetes, lower blood pressure, lower cholesterol levels, and
produce other potentially beneficial biochemical changes in the body. It
probably explains why some beneficial changes are seen even with qualitatively
unhealthy diets, such as the quackish low-carbohydrate diets that have become
the latest fad. Reducing caloric intake in mid-life is probably almost as
effective as beginning the calorically restricted diet in childhood, and adults
probably do not need to cut calories as much as children do to achieve the
beneficial effects. Care must be taken to insure that adequate amounts of all
nutrients are consumed.

A vegetarian diet facilitates this approach because of the bulk of plant
foods, and reduced caloric intake is most likely one of the important mechanisms
by which healthful vegetarian diets promote health and longevity.

There are mainly two groups that advocate this position: 1) those in the
nutrition business who are in the pocket of various food industry groups, and 2)
people who have no limits in their lives, which are manifested by an "if it
feels good, do it" philosophy.

Is it okay to smoke cigarettes in moderation? After all, even apple sauce in
excess can be harmful, according to one tobacco company executive. True,
cigarettes have no redeeming value whereas foods contain nutrients. But if you
can get the same nutrients from foods A and B, and you know that B contains
substances that may be harmful to health whereas A does not, then why consume B
at all?

Similarly, is it okay for Jews, Moslems, Buddhists, Seventh Day Adventists,
or ethical vegetarians to eat just a little pork? Clearly not. If anything, the
lives of people who place limits on their daily functions and activities are
enhanced by the experience. They've developed a self-discipline that keeps them
from feeling deprived just because they can't follow every temptation, even in
"moderation." Those who feel threatened by recommendations not to eat one food
or another would greatly benefit from the development of this type of
self-discipline.